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Diabetes: Clinical Approaches

With Allan E. Sosin, M.D.Author of The Doctor's Guide to
Diabetes and your Child

What is the most common mistake that you believe is made in
treating diabetic patients?

Starting them on medication without first making lifestyle
changes. If the medication is initially effective in controlling the
blood sugar, the patient may not implement essential lifestyle
changes to prevent future problems. Elevated blood sugar is only a
single factor in a combination of problems that have come to be known
as Metabolic Syndrome. Patients are subject not only to developing
diabetes mellitus, but serious cardiovascular complications such as
heart attacks and strokes. Management must not involve simply trying
to lower the blood sugar, but also improving the many lifestyle
factors that contribute to disease. Major changes are necessary in
eating habits, exercise, stress reduction, and especially in
understanding of the effect of food on health. Nutritional
supplements also have great value in support of the diabetic patient,
both by improving blood sugar control and by reducing end organ
damage and preserving function of the kidneys, eyes, nervous and
cardiovascular systems.

People should be aware of the fact that the benefit of medication
on blood sugar control is often temporary. Over time, the medication
becomes less effective as the individual sinks deeper into insulin
resistance and overweight. Additional medications become necessary
with their myriad side effects and ultimate ineffectiveness. Some of
the diabetes medications actually result in weight gain, serving to
worsen the overall problem. I rarely start a diabetic patient on
medication during the first visit. I believe it is important for
patients to appreciate the changes that can occur with lifestyle
change and the initiation of nutritional supplements to enhance
insulin effect.

The American Diabetic Association considers glycemic index as
relatively unimportant in the selection of food for diabetics. Do you agree?

The glycemic index has great importance in choosing the proper
diet. It does not however provide the only valuable guideline. High
glycemic index foods should usually be avoided because they make
blood sugar control more difficult, raise cholesterol and
triglycerides, and increase weight. Not all high glycemic foods are
forbidden. I think, for instance, that carrots provide great
nutritional benefits and may be included in the diabetic diet if they
are combined with other foods having a lower glycemic index. The
nutrient content of foods is also an important factor, as is fiber
content.

Do you wean type 2 diabetics off medication? If so, how and
when?

Yes. In taking a type 2 diabetic off medication, the blood sugar
should be closely followed. Medication may gradually be reduced,
provided the blood sugar does not rise excessively. I have seen many
individuals reduce medications or eliminate them entirely while
keeping the blood sugar in the normal range. When lifestyle changes
in diet, exercise and nutritional supplementation are rapidly made,
it is important to reduce the dosage of medication early. Otherwise
the patient may be at risk of hypoglycemia, particularly if
sulfonylurea drugs are used.

Dr. Sosin is the Director of The Institute
for Progressive Medicine in Irvine, California. He was previously
the Medical Director of the Whitaker Wellness Institute in Newport
Beach.

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